Part 1: Overview of the Program
The adoption and implementation of effective, economical, and sustainable evidence-based health improvement programs have never been more in demand. As more Baby Boomers turn 65 in 2011 and as health care costs continue to rise, it is vital that service organizations find ways to empower diseased and at-risk individuals to take more control of their health destiny. Because most major chronic diseases are closely related to lifestyle choices, including poor nutrition and lack of physical activity, effective behavior change programs offer an economical means of reducing healthcare costs and improving quality of life.
The Stanford Chronic Disease Self-Management Program (CDSMP) is an effective behavior change program that has been successfully implemented in a variety of settings. This article will first describe the program and then relate implementation experiences on statewide and local levels in North Carolina.
Part 2: Lessons Learned from Statewide Implementation
Various entities throughout North Carolina—from universities to health departments to healthcare services managers—have dabbled in the adoption and implementation of CDSMP for several years. However, the expansion of the program, dubbed Living Healthy, hit its stride when the North Carolina Division of Aging and Adult Services (DAAS) and Division of Public Health (DPH) received a three-year grant for the dissemination of evidence-based health promotion and disease prevention programs from the U.S. Administration on Aging (AoA) in 2007. At that time, there were already two CDSMP T-Trainers and a handful of Master Trainers in North Carolina. The infusion of new funds allowed DAAS and DPH to begin building upon this small existing network of trainers to launch a much larger statewide infrastructure, with a broad reach to North Carolinians with chronic health conditions.
Part 3: Lessons Learned from Local Implementation
As one of the original CDSMP grantees in North Carolina, the Centralina Area Agency on Aging has been responsible for implementing the Living Healthy program in the nine counties surrounding Charlotte. Now in our fourth year of offering Living Healthy for participants with chronic conditions, the addition of the Living Healthy with Diabetes program in the past year has increased our program offerings in the region. Five Master Trainers and 46 Lay Leaders conducted 20 Living Healthy workshops and 3 diabetes workshops over the last calendar year with almost 300 participants.
During the initial startup of the program, we found that identifying key partners was crucial to the success of the program. Such collaborations can include senior centers, parks and recreation departments, retirement facilities, nutrition programs, senior volunteer programs, county agencies such as social services and departments of aging, and other nonprofit organizations such as Arthritis Services and the Multiple Sclerosis Society. These agencies have been a vital part of the program by offering staff and key volunteers who are trained as Master Trainers and Lay Leaders. The agencies support trainers and leaders by allowing them the time to provide training in the community as well as the time away from their regular positions to become certified as leaders. Many agencies also offer space for workshops. Centralina asks all partnering agencies to sign a memorandum of agreement in which the expectations of both parties are clearly explained. Leaders also sign an agreement in which they commit to teach a certain number of workshops and adhere to the fidelity of the program.
The Stanford Chronic Disease Self-Management Program is a prime example of an evidence-based behavior change program that has been successfully adopted and implemented on the state and local levels with diverse populations. However, its success clearly depends on the infrastructure and resources of the organization through which it is offered. It is prudent for an organization to fully evaluate its resources and learn from others who have already adopted and implemented the program in order to maximize results and minimize potential problems.